Impact of device implantation depth on blood flow dynamics after left atrial appendage closure
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Device-related thrombus (DRT) remains a concern after left atrial appendage closure (LAAC), particularly when the device is deeply implanted. However, the mechanistic links between implantation depth, flow dynamics, and DRT risk are not well understood. AIMS: We therefore aimed to evaluate the impact of LAAC device implantation depth on local flow characteristics and its association with DRT using patient-specific computational fluid dynamics (CFD). METHODS: The study included 285 patients undergoing LAAC with either Amplatzer Amulet or WATCHMAN devices at 10 centres. Patient-specific CFD simulations were performed using postprocedural computed tomography and echocardiography-derived boundary conditions to assess blood flow dynamics. The primary endpoint was the comparison of CFD-derived flow indices - device surface velocity index (DSVI), endothelial cell activation potential (ECAP), and the presence of eddies/stagnated flow - between proximal and distal device implantation groups. Secondary analyses explored the relationship between these flow features and DRT. RESULTS: Proximal implants (57.2%) showed more favourable flow patterns: higher DSVI (0.11 m/s vs 0.09 m/s; p=0.002), lower ECAP (0.75 vs 0.90; p=0.003), and fewer recirculating zones (40.5% vs 74.6%; p<0.001). DRT incidence increased with greater implantation depth, paralleled by worsening flow indices. A composite CFD-based DRT risk score, incorporating ECAP, implantation depth, and flow complexity, demonstrated good discrimination (area under the receiver operating characteristic curve [AUC] 0.81), outperforming anatomical depth alone (AUC 0.71). CONCLUSIONS: Deeper LAAC device implantation is associated with adverse flow profiles and a higher risk of DRT. CFD-based flow characterisation may enhance risk stratification beyond anatomical criteria alone. Further studies incorporating clinical variables are warranted to validate these methods.
Source: EuroIntervention
Authors: Pedro Cepas-Guillén, Carlos Albors, Jordi Mill, Adel Aminian, Philippe Garot, Ole De Backer, Jens Erik Nielsen-Kudsk, Xavier Iriart, Manuel Barreiro-Perez, Eduardo Flores-Umanzor, Ignacio Cruz-González, Dabit Arzamendi, Marisa Avvedimento, Luis Nombela-Franco, Nina Leduc, Jérôme Horvilleur, Klaus Fuglsang Kofoed, Kasper Korsholm, Hubert Cochet, Rodrigo Estevez-Loureiro, Manal Barrouhou, Ana Lafond, Xavi Millán, Laura Sanchis, Josep Rodés-Cabau, Oscar Camara, Xavier Freixa
Institutions: Hospital Clínic de Barcelona, Consorci Institut D'Investigacions Biomediques August Pi I Sunyer, Universitat Pompeu Fabra, Grand Charleroi Hospital, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Rigshospitalet, Aarhus University Hospital, Université de Bordeaux, Inserm, Electrophysiology and Heart Modeling Institute, Hôpital Cardiologique du Haut-Lévêque, Servicio Gallego de Salud, Universidade de Vigo, Instituto de Investigación Biomédica de Salamanca, Hospital de Sant Pau, Institut universitaire de cardiologie et de pneumologie de Québec, Université Laval, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7153988992